PROSPECTIVE RANDOMIZED EVALUATION OF BLOOD SALVAGE TECHNIQUES FOR PRIMARY TOTAL HIP-ARTHROPLASTY

A controlled, randomized, prospective study was performed evaluating t he need for perioperative blood salvage for primary total hip arthropl asty patients who had donated autologous blood before surgery. One hun dred fifty-three patients able to donate at least 2 units of autologou s blood were divided into four groups. In group 1 (35 patients), intra operative and postoperative Cell-Saver (Haemonetics, Braintree, IMA) w as employed. In group 2 (40 patients), a postoperative Solcotrans (Smi th & Nephew Richards, Memphis, TN) reinfusion protocol was followed. I n group 3 (40 patients), a closed-suction Hemovac drain (Zimmer, Warsa w, IN) was placed. In group 4, (38 patients), no drain was used. Decis ions for transfusion were based on clinical and laboratory parameters and made in conjunction with medical consultation. All autologous bloo d was routinely reinfused. There was no statistically significant diff erence in transfusion requirements or wound complications among the fo ur groups. Hemoglobin and hematocrit changes between groups also were not statistically significant, but a power test suggested insufficient patient numbers for absolute reliability of this observation. Only fi ve patients (3.3%) in this study received homologous blood. Four of th ese patients were in the Solcotrans group and one was in the Cell-Save r group. Two reoperations were performed: one for hematoma (Solcotrans group) and one for a sewn-in drain. It is concluded that expensive pe rioperative blood salvage techniques are usually not needed in patient s who have a primary total hip arthroplasty without cement and who hav e donated 2 units of blood before operation.